The 'great debate': Fisher vs Singer

I had heard it described as the 'clash of the titans' and other similarly grand claims evocative of gladiatorial contests of one kind or another.But for those who have known or observed Sydney Archbishop, Anthony Fisher and Professor Peter Singer in any previous forum, a titanic battle was never really on the cards.Marketed simply as 'The Euthanasia Debate: Singer v Fisher' the event at the Sydney Town Hall last week was, as described by one journalist, an event where: 'arguments flew in both directions but rarely met'. It was a respectful exchange from two well-credentialed people whose views were never really expected to coalesce upon common ground.Fisher's was a straight forward approach. In his opening remarks he drew moral distinctions between killing in response to suffering and actively supporting and engaging in answering the needs of the sufferer until death summarizing that the latter 'demands more from us' endorsing, as it does, the intrinsic value of human life. He went on from that point to discuss the effect upon humanity of accepting the view that some lives would be worth less than others.Singer's approach, by contrast, was anything but straightforward. He began by framing the debate on his own terms. For some, his assertion that he accepted a definition of 'voluntary euthanasia' as put by Archbishop Fisher in a debate some years ago will have seemed conciliatory, perhaps even charitable. It was, in reality, a slight of hand. 

"An act or calculated course of omission intended to shorten life with a supposedly merciful motivation."

Singer said that he accepted this definition, 'so we don't have to argue'. However, after then making some entirely unremarkable comments about what 'voluntary' means, he moved immediately to argue that physician assisted suicide is included in the above definition. Certainly, there are similarities and certainly, as he later observed, there may be little in the way of 'ethical significance in the distinction' but there's a little devil in the detail here and 'method in the madness'.

Physician Assisted Suicide (PAS) as is practiced in certain places, involves the provision of the means by which a person can commit suicide. In states in the USA where it is practiced it is normally about a doctor prescribing a lethal substance that the person later ingests. (By the way, he was wrong to say that PAS is legal in Montana) The distinction between PAS and euthanasia is essentially about who actually does the killing.

Fisher's definition is a definition for euthanasia. If it were about 'voluntary euthanasia' it would require an additional phrase relating to consent. In thinking about the 'agreed definition' however, it is, at the very least, a very large 'stretch' to include PAS. PAS cannot be by omission and, normally understood, it is an act intended to provide the means to shorten life - a short and intrinsically connected step, certainly, but one that should not be overlooked. As it happened, making this 'fudge' allowed Singer to focus almost exclusively on the US experience with PAS and to virtually ignore talking about the European 'Low Countries'.

Making a great deal about the use of the word 'voluntary' meant that Singer could also avoid discussion about euthanasia where evidence of request or consent was notably absent. Surely, if we are talking about legislation that has such grave and irremediable outcomes, we must discuss all aspects including whether or not the law will function as intended and, therefore, whether saying it is 'voluntary' is an effective safeguard against abuse of consent?

Evident throughout his words, this became most obvious in question time where he refused to answer a question from Daniel Pask (pictured) related to the euthanasia deaths of infants in The Netherlands who were born with spina bifida (except to note that only about 20 such deaths had occurred) and the Belgian law change in 2013 that allows euthanasia for children, saying that these cases are 'not voluntary' (and therefore, somehow, beyond the tems fo the debate).

The Groningen Protocol (under which euthanasia for disabled infants has been allowed in Holland since 2005) and the Belgian law change in 2013 both require informed consent by the parents. The principle of parents making decisions for minors in their care is well understood and fulfils even Singer's definition of 'voluntary' as being by way of an 'informed and considered request'.

All of this 'fudging' allowed Singer to claim that there was no evidence of a 'slippery slope' going so far as to rebut Fisher's claims to the contrary by calling it a 'wilful refusal to look at the evidence' and citing only the data from Oregon USA in his defence.

In one of his very few references to Europe (cited as additional evidence of 'no slippery slope here'), he curiously claimed that because the Dutch had experienced in recent history a government by the Christian Democrats (who did not move to overturn the euthanasia laws) and that the Dutch people think the law works well, that there is no slippery slope. This is hardly 'evidence' as he or even any non-academic person would understand it.

Singer did admit that he sees necessary limits on the exercise of autonomy, saying that he was, 'not an absolutist'. He gave the example of a love-sick younger person who might later see that he or she had much to live for in a life where 'on balance' there might be more good than bad. But what if this putative 'person on the ledge' were to have had some degenerative condition that subjectively, in Singer's terms might tip the 'balance' the other way?

And that, ultimately, is the problem with Singer's thinking and the problem with euthanasia and assisted suicide: it's all about a subjective, utilitarian view of the value of life. Singer's problem is fundamental. He tried to define the reasons why killing is wrong (traditionally) as the loss of a person's future autonomous decision making capability and the loss of possibility of future 'good experiences'. He then flipped the argument over by saying that these concerns are reversed with euthanasia. If the value of life is not intrinsic and unalienable, then Singer's views, which include, by the way, the killing of infants with disabilities, are at least logically consistent.

But society offers continuous commentary in a myriad of ways that stands against Singer's views. We don't support suicide prevention only for those whose lives and experience fits with our own subjective values. We don't offer care only to those who live exemplary lives. We sympathize with those grieving the loss of a loved one making no distinction about misadventure, lifestyle choices etc. In other words, we recognise that life has intrinsic value not affected and not diminished by anything external. Certainly, we will often think in terms of a 'life cut short', but we do not define that life solely nor primarily in those terms.

Archbishop Fisher observed: 'Once you accept some people are better off dead a moral line is crossed.' He is right; this is unavoidably a matter of moral significance. It cannot be simply waved away.

Nor can we ignore the legitimate concerns of those whose lived experience makes them fearful of the advent of patient killing. Singer may well have kicked the question about the relationship between disability and euthanasia into the long grass. It suited his presentation to do so. But the reality remains.

Disability Advocate, Craig Wallace, was critical of Singer, his philosophy and views on disability in a published response on Crikey.com. Observing that, 'if proponents of voluntary euthanasia were looking to reassure us that legalised suicide would, in fact, be voluntary and not about people with disabilities, they chose the wrong standard bearer.'

He went on to make the connection crystal clear:

'My challenge to advocates of voluntary euthanasia who insist it would "never be about someone like you", as they invariably do, would be to ask them to specifically rule us out or rule something in.

'If euthanasia is truly only about forestalling the excruciating final hours of people with conditions like end-stage cancer, then why not list the illnesses that are covered in clear diagnostic terms?

'Because euthanasia legislation consistently defines eligibility through terms like "terminal or irremediable illnesses" the extent of coverage remains opaque.

'When does a condition become terminal, exactly? Most medical practitioners would say that a disability like mine shortens the lifespan. There is no clearly defined boundary between a shortened life span and a terminal illness.

'When is a condition "irremediable"? Many disabilities are permanent and a person might be unable to move, eat, walk or shower without the support of another person. I know many people with disabilities that look like this. And, at the time they acquired their disabilities, they have told me they want to die.

'Yet talk to them a few years down the track and they have gone on to live lives that are different, yet productive and meaningful, including raising a family and resuming a career. What's been remediated in the meantime is not their disability, but barriers and a lack of supports in their lives.'

Singer's reductive arguments are dangerous. His philosophy is not only utilitarian but he seems also to operate in a utopian fog when he assumes without question that permissive euthanasia laws will work and not be abused. His is a warped view of the value of life. The consequences, in the real world, of this thinking are ultimately eugenic. His world would actively exclude people like Craig Wallace and Daniel Pask from full membership.

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